Provider Network Reports. The Contractor shall submit a report to the Department, in a format specified by the Department, to demonstrate that the Contractor offers an appropriate range of Covered Services that is adequate for the anticipated number of Enrollees in the Service Area and that the Contractor maintains a network of Providers that is sufficient in number, mix and geographic distribution to meet the needs of the anticipated number of Enrollees in the Service Area.
Provider Network Reports. 110 12.6 MEMBER COMPLAINTS.............................................................111 12.7
Provider Network Reports. The Contractor shall submit a monthly electronic file of its Participating Provider network that meets the Department’s provider file specifications and data element requirements to the Department.
Provider Network Reports. 12.5.1 Provider Network Report. HMO must submit to the Enrollment Broker an electronic file summarizing changes in HMO's provider network including PCPs, specialists, ancillary providers and hospitals. The file must indicate if the PCPs and specialists participate in a closed network and the name of the delegated network. The electronic file must be submitted in the format specified by TDH and can be submitted as often as daily but must be submitted at least weekly.
Provider Network Reports. The CONTRACTOR shall notify HSD within five (5) working days of any unexpected changes to the composition of its provider network that negatively affects member access or the CONTRACTOR'S ability to deliver all services included in the benefit package in a timely manner. Any anticipated material changes in the CONTRACTOR'S provider network shall be reported to HSD in writing when the CONTRACTOR knows of the anticipated change or within thirty (30) calendar days, whichever comes first. The notice submitted to HSD shall include the following information: Nature of the change; Information about how the change affects the delivery of covered services or access to the services; and the CONTRACTOR'S plan for maintaining the access and quality of member care.
Provider Network Reports. The CONTRACTOR shall notify HSD/MAD within five (5) working days of any unexpected changes to the composition of its provider network that negatively affect member access or the CONTRACTOR’S ability to deliver all services included in the benefit package in a timely manner. Any anticipated material changes in the CONTRACTOR’S provider network shall be reported to HSD/MAD in writing when the CONTRACTOR knows of the anticipated change or within thirty (30) calendar days, whichever comes first. The notice submitted to HSD/MAD shall include the following information: nature of the change; information about how the change affects the delivery of covered services or access to the services; and the CONTRACTOR’S plan for maintaining the access and quality of member care. In the event that substantial or material provider network changes occur, including when it is determined that a provider is otherwise unable to meet its contractual obligation, the CONTRACTOR shall be required to submit transition plans to HSD/MAD. The CONTRACTOR shall provide member demographic information, date or anticipated date of transition, any special conditions or barriers to transition, and other related information requested by HSD/MAD. Article 5 (COMPENSATION & PAYMENT REIMBURSEMENT FOR MANAGED CARE) Section 5.6.(4). is amended to read as follows:
Provider Network Reports. 58 ------------- (a) PCPs and Specialists Report..........................................................................58 (b) Provider Network Change Report.......................................................................58
Provider Network Reports. (a) PCPs and Specialists Report CONTRACTOR must submit to HHSC by the date of the readiness review an electronic listing of all PCPs participating in their network. The format for this report is contained in Appendix K. CONTRACTOR must also submit to HHSC by the date of the readiness review an electronic listing of all specialists participating in their network. The format for this report is contained in Appendix L to the RFP.
Provider Network Reports. 2.30.7.1 The CONTRACTOR shall submit a monthly Provider Enrollment File that includes information on all providers of TennCare health services, including physical, behavioral health, and long-term care providers (see Section 2.11). This includes but is not limited to, PCPs, physician specialists, hospitals, home health agencies, CMHAs, nursing facilities, HCBS providers, and emergency and non-emergency transportation providers. For HCBS providers, the Provider Enrollment File shall identify the type(s) of HCBS the provider is contracted to provide and the specific counties in which the provider is contracted to deliver HCBS, by service type. The report shall include contract providers as well as all non-contract providers with whom the CONTRACTOR has a relationship. The report shall be sorted by provider type. The CONTRACTOR shall submit this report during readiness review, by the 5th of each month, and upon TENNCARE request. Each monthly Provider Enrollment File shall include information on all providers of covered services and shall provide a complete replacement for any previous Provider Enrollment File submission. Any changes in a provider’s contract status from the previous submission shall be indicated in the file generated in the month the change became effective and shall be submitted in the next monthly file.
Provider Network Reports. 12.5.1 Provider Network Change Reports. HMO must submit a monthly report summarizing changes in HMO's provider network. The report must be submitted to TDH in the format specified by TDH. HMO will submit the report thirty (30) days following the end of the reporting month. The report must identify provider additions and deletions and the impact to the following:
